1. A Response to ACEs in the Health Care Setting Ideas to Assess Trauma & Implement Trauma Informed Care

2. Trauma in the Health Care Setting Injuries Illnesses Preventive Health Care

3. What Trauma Sounds Like in a Health Care Setting The Patient “I thought I was going to die. I was so scared because my mom was not there.” “Doctors crowded around and stuck stuff on me. They cut my clothes off. I didn’t know what was happening” “I’m afraid to do many of the things I used to do.” “Even now some things bring it all back. Some smells – like the smell of metal pipes. I only need one thing to happen and then the day is practically useless.” Source: Center for Pediatric Traumatic Stress, Children’s Hospital of Philadelphia

4. What Trauma Sounds Like in a Health Care Setting The Family “I saw my son lying in the street, everyone around him. It was a horrible scene. I thought I was dreaming.” “We went from taking our child to the family doctor thinking she had the flu, but by the end of the day we were in the PICU and she was covered with needles, tubes and monitors.” “For a long time, we were so afraid of everything. Afraid he was going to die, afraid he wouldn’t have a normal life.” Source: Center for Pediatric Traumatic Stress, Children’s Hospital of Philadelphia

5. What Trauma Sounds Like in a Health Care Setting The Health Care Professional “She is the same age as my daughter.” “The day was absolutely insane. We saw twice the number of patients as normal.” “I felt so frustrated and wished there was more that we could do.” “What were they thinking? Why on earth would you not wear a seat belt?”

6. Key Reminders for Health Care Professionals Trauma affects the entire family & broader systems Don’t forget to check the family trauma history A trauma response may look different in each person, but a consistent feeling is one of helplessness Empower the patient and their family to assist in their care & recovery Trauma may impact child development, and a person’s behavior, long-term health and mental health Protective & promotive factors can reduce the adverse impact of trauma Culture is closely interwoven with traumatic experiences, response & recovery Don’t assume you understand a patient’s culture and values…ask

7. Ideas to Assess & Respond to ACEs One question - “Is there anything that scares or worries you?” After the ABCs (Airway, Breathing, Circulation) consider the DEF Distress – Pain, fears or worries, grief and loss Emotional support – mobilize existing & identify new supports Family – assess parent & sibling distress, other needs beyond medical Source: Medical Traumatic Stress, National Child Traumatic Stress Network Assessments Psychosocial history gathering (patient & family) Organizational assessment (trauma informed policies, practices & environment) Multidisciplinary Team approach Problem Based Learning (PBL) – facts, hypotheses, next steps, learning issues Source: NCTSN Learning Collaborative

8. Ideas for Responding to ACEs Care for the Health Care Professional Secondary Trauma - the stress resulting from helping or wanting to help a traumatized or suffering person Vicarious Trauma - the cumulative effect of working with victims who experience traumatic life events Professional Quality of Life Scale www.proqol.orgwww.proqol.org Psychological First Aid – method for debriefing ABCs of Self Care Awareness Balance Connection

9. References & Resources Bassuk, E. et al, Understanding Traumatic Stress in Children, National Center on Family Homelessness (2006). Fallot & Harris, Creating Cultures of Trauma Informed Care: A Self Assessment and Planning Protocol, Community Connections (2009). Felitti & Anda, Adverse Childhood Experience (ACE) Study, Centers for Disease Control and Prevention (2009). Van Dernot Lipsky, L., Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others (2009). Bloom & Farragher, Destroying Sanctuary: Crisis in Human Service Delivery Systems (2011). Stamm, B., Secondary Traumatic Stress: Self-Care Issues for Clinicians, Research & Educators (1999). Figley, C., Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized (1995).

10. Websites National Center on Trauma Informed Care http://www.samhsa.gov/nctichttp://www.samhsa.gov/nctic National Child Traumatic Stress Network http://www.nctsn.orghttp://www.nctsn.org Secondary Trauma http://www.secondarytrauma.orghttp://www.secondarytrauma.org Professional Quality of Life Scale http://www.proqol.orghttp://www.proqol.org Trauma Informed Care Project http://www.traumainformedcareproject.orghttp://www.traumainformedcareproject.org